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Showing results for "happened".

1321. News Media and Health Care Providers at the Crossroads of Medical Adverse Events (pdf file)
      www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety-2/vol1/Advances-Whitten_85.pdf
      June 05, 2008 - News Media and Health Care Providers at the Crossroads of Medical Adverse Events News Media and Health Care Providers at the Crossroads of Medical Adverse Events Pamela Whitten, PhD; Mohan J. Dutta, PhD; Serena Carpenter, PhD; Graham D. Bodie Abstract In 2005, Indiana Governor Mitch Daniels issued an executi…

1322. The Nature, Characteristics and Patterns of Perinatal Critical Events Teams (pdf file)
      www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety-2/vol3/Advances-Riley_58.pdf
      April 02, 2008 - The Nature, Characteristics and Patterns of Perinatal Critical Events Teams The Nature, Characteristics and Patterns of Perinatal Critical Events Teams William Riley, PhD; Helen Hansen, PhD, RN; Ayse P. Gürses, PhD; Stanley Davis, MD; Kristi Miller, RN, MS; Reinhard Priester, JD Abstract The Institute …

1323. Seamless Care: Safe Patient Transitions from Hospital to Home (pdf file)
      www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety/vol1/Spehar.pdf
      April 18, 2004 - underlying assumption in the discharge planning process that the patient’s providers knew what had happened

1324. Final Progress Report: Risk of Acute Asthma Associated with the Pediatric Use of Opioids (pdf file)
      www.ahrq.gov/sites/default/files/2024-02/chen-report.pdf
      January 01, 2024 - Given most of these asthma -related events happened on average 5 to 6 months before the index analgesic

1325. Final Progress Report: Multicenter Medication Reconciliation Quality Improvement Study (MARQUIS) (pdf file)
      www.ahrq.gov/sites/default/files/2024-01/schnipper-report.pdf
      January 01, 2024 - and in temporal trends as well as sudden improvement in control units at the time the intervention happened

1326. Final Progress Report: The PeaceHealth Community-wide Electronic Shared Medication List (pdf file)
      www.ahrq.gov/sites/default/files/2024-07/stock-easton-report.pdf
      January 01, 2024 - this clinic, we have defined protocols about reporting and discussing medication mistakes that almost happened

1327. CAHPS Transcript: Strategies for Improving CAHPS Health Plan Survey Scores (pdf file)
      www.ahrq.gov/sites/default/files/wysiwyg/cahps/news-and-events/events/20160413/hp-survey-strategies-webcast-transcript.pdf
      April 01, 2016 - Well, one of the things I learned after this happened with us is that in talking with other systems about

1328. Community Connections: Linking Primary Care Patients to Local Resources for Better Management of Obesity (pdf file)
      www.ahrq.gov/sites/default/files/publications/files/obesity-toolkit.pdf
      March 01, 2014 - Community Connections: Linking Primary Care Patients to Local Resources for Better Management of Obesity Community Connections Linking Primary Care Patients to Local Resources for Better Management of Obesity Prepared for: Agency for Healthcare Research and Quality U.S. Department of Health…

1329. AHRQ-Funded Patient Safety Highlights: Improving Healthcare Safety by Supporting Measure Implementation (pdf file)
      www.ahrq.gov/sites/default/files/wysiwyg/patient-safety/highlights/ps-project-highlights-measure-implementation.pdf
      August 01, 2025 - Patients wanted disclosure of all harmful errors and sought information about what happened, why the … error happened, how the error’s consequences will be mitigated, and how recurrences will be prevented

1330. Final Progress Report: Risk-Informed Interventions in Community Pharmacy: Implementation and Evaluation (pdf file)
      www.ahrq.gov/sites/default/files/2024-02/cohen2-report.pdf
      January 01, 2024 - Final Progress Report: Risk-Informed Interventions in Community Pharmacy: Implementation and Evaluation Final Report: Risk-Informed Interventions in Community Pharmacy: Implementation and Evaluation Principal Investigator: Michael R. Cohen, RPh, MS, ScD (hon), DPS (hon) Team Members: Judy L. Smetzer, RN, BSN,…

1331. AHRQ Medical Office Survey on Patient Safety Culture: User’s Guide (pdf file)
      www.ahrq.gov/sites/default/files/wysiwyg/sops/surveys/medical-office/Medical-Office-Users-Guide-2021.pdf
      January 01, 2021 - AHRQ Medical Office Survey on Patient Safety Culture: User’s Guide USER’S GUIDE MEDICAL OFFICE SURVEY ON PATIENT SAFETY CULTURE PATIENT SAFETY AHRQ Medical Office Survey on Patient Safety Culture: User’s Guide Prepared for: Agency for Healthcare Research and Quality U.S. Department of Health and Human …

1332. Case 2. Central Hospital | Agency for Healthcare Research and Quality
      www.ahrq.gov/practiceimprovement/systemdesign/leancasestudies/lean-case2.html
      November 01, 2014 - Improving Care Delivery Through Lean: Implementation Case Studies Case 2. Central Hospital Previous Page Next Page Table of Contents Improving Care Delivery Through Lean: Implementation Case Studies Introduction to the Case Studies Case 1. Lakeview Healthcare Case 2. Central Hospital Case 3.…

1333. Creating a Culture of Patient Safety through Innovative Hospital Design (pdf file)
      www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety/vol2/Reiling.pdf
      January 01, 2004 - Creating a Culture of Patient Safety through Innovative Hospital Design 425 Creating a Culture of Patient Safety through Innovative Hospital Design John G. Reiling Abstract When SynergyHealth, St. Joseph’s Hospital of West Bend, Wisconsin, decided to relocate and build an 82-bed acute care facility, we reco…

1334. Do Transient Working Conditions Trigger Medical Errors? (pdf file)
      www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety/vol1/Grayson.pdf
      January 01, 2003 - Do Transient Working Conditions Trigger Medical Errors? 53 Do Transient Working Conditions Trigger Medical Errors? Deborah Grayson, Stuart Boxerman, Patricia Potter, Laurie Wolf, Clay Dunagan, Gary Sorock, Bradley Evanoff Abstract Objective: Organizational factors affecting working conditions for health …

1335. Outpatient Surgery and Patient Safety—The Patient’s Voice (pdf file)
      www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety/vol4/Hundt.pdf
      January 01, 2003 - Outpatient Surgery and Patient Safety—The Patient’s Voice 445 Outpatient Surgery and Patient Safety— The Patient’s Voice Ann Schoofs Hundt, Pascale Carayon, Scott Springman, Maureen Smith, Kelly Florek, Rupa Sheth, Margaret Dorshorst Abstract Four outpatient surgery centers from a large Midwestern communit…

1336. Failure Modes and Effects Analysis Based on In Situ Simulations: A Methodology to Improve Understanding of Risks and Failures (pdf file)
      www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety-2/vol3/Advances-Davis_60.pdf
      April 07, 2008 - Failure Modes and Effects Analysis Based on In Situ Simulations: A Methodology to Improve Understanding of Risks and Failures Failure Modes and Effects Analysis Based on In Situ Simulations: A Methodology to Improve Understanding of Risks and Failures Stanley Davis, MD; William Riley, PhD; Ayse P. Gurses, PhD; Kr…

1337. Final Progress Report: Patient Safety Learning Laboratory to Enhance the Value and Safety of Neonatal Interfacility Transfers in a Regional Care Network (pdf file)
      www.ahrq.gov/sites/default/files/2025-02/umoren-report.pdf
      January 01, 2025 - Final Progress Report: Patient Safety Learning Laboratory to Enhance the Value and Safety of Neonatal Interfacility Transfers in a Regional Care Network Patient Safety Learning Laboratory to Enhance the Value and Safety of Neonatal Interfacility Transfers in a Regional Care Network Rachel A. Umoren, MBBCh, MS Mega…

1338. Webinar Transcript - The National Quality Strategy and the Public Sector: Federal Agency Alignment to the Six Priorities | Agency for Healthcare Research and Quality
      www.ahrq.gov/workingforquality/events/webinar-federal-agency-alignment-to-the-six-priorities.html
      November 01, 2016 - Webinar Transcript - The National Quality Strategy and the Public Sector: Federal Agency Alignment to the Six Priorities July 21, 2016 Download accessible version of slides (PDF, 1 MB) The National Quality Strategy and The Public Sector [Slide 1] Operator: Ladies and gentlemen, thank you for stand…

1339. Webinar Transcript: Better Care, Healthier People and Communities, More Affordable Care: 5 Years of the National Quality Strategy | Agency for Healthcare Research and Quality
      www.ahrq.gov/workingforquality/events/webinar-better-care-healthier-communities.html
      November 01, 2016 - Webinar Transcript: Better Care, Healthier People and Communities, More Affordable Care: 5 Years of the National Quality Strategy May 17, 2016 Download accessible version of slides (PDF, 1.9 MB) Better Care, Healthier People and Communities, More Affordable Care: 5 Years of the National Quality Strategy…

1340. Final Progress Report: Measuring Quality of Primary Care in Complex Pediatric Patients (pdf file)
      www.ahrq.gov/sites/default/files/2025-02/chen-report.pdf
      January 01, 2025 - Final Progress Report: Measuring Quality of Primary Care in Complex Pediatric Patients Title: Measuring Quality of Primary Care in Complex Pediatric Patients Principal Investigator: Alex Y. Chen, MD, MS Organization: Children’s Hospital Los Angeles Inclusive Dates of Project: 07/01/2009- 06/30/2012 Federal Projec…